Most clinical providers are aware of the more common capacities of EHRs. However, there are many capacities that are being underused that can be of great assistance in providing safe care that avoids waste and identifies best practices. Electronic communication with providers outside of one’s clinical setting, clinical decision support and improving the body of knowledge of best practices are three of the advanced capacities of modern EHRs.
More than half of all clinical providers now use an EHR at their site. While leaning to use the EHR is a challenge most providers agree that it improves the safety of care for patients. With the use of an EHR the problem of unreadable handwriting is eliminated. Thus, other clinicians in an office and also office staff have little difficulty understanding notes from a patient visit. Drop-downs in the office visit templates make communication more uniform and any notes added in text boxes are legible.
Another commonly recognized efficiency of EHRs is the features of e-prescribing. E-prescribing eliminates miscommunication between providers and pharmacies. It also increases office efficiency since fewer staff are involved in providing and communicating refills to pharmacies. If a patient is on multiple medications, then an EHR can alert a physician or nurse to dangerous interactions of a new prescription to existing prescriptions if all of a patient’s medication data is entered into the EHR.
If a practice uses an EHR that is installed on hardware that is housed at the clinical site, then the staff at the site certainly have access to the data in the EHR. This may be the extent of the sharing of the data, though, especially if the clinical practice does not provide services at other sites. If a clinical service organization is spread across several sites, then the organization should have its EHRs interconnected across all of its sites. Connecting EHRs across several physical settings is not overly difficult and is much like intranets used by many businesses. If these connections are secure from outside breach then HIPAA compliance can be achieved. Of course, the challenges of connecting hardware and EHRs across multiple settings is eliminated if cloud EHRs are used.
What are the advantages of having connected EHRs? Let me illustrate a brief example. I have a friend who had neck surgery. In a follow-up visit to her surgeon’s office she first had to go a lab located in a hospital nearby for an x-ray. After the x-ray I took her to the surgeons office for her checkup. Because the surgeon was electronically hooked up to the hospital through an EHR the x-ray image was available for him for her visit. The visit was much more effective because the surgeon was able to access the most recent images.
EHRs coupled with clinical decision support software can greatly improve a physicians capacity to deliver effective care. In a recent report from the Institute of Medicine, Best Care at Lower Cost, over 2100 clinical and biomedical research papers are published everyday. Of course many of these are not useful in a given setting. The fact remains, that research and practice information is emerging too quickly for physicians to become familiar with the outcomes. For instance, it took 13 years for most experts to recommend thrombolytic drugs for heart attack treatment after its first indication of effectiveness in clinical trials. This slow pace of adoption was the result of the methods that clinicians found out about research, through medical journals. Things have changed since then. According to the IOM report, 86% of physicians use the Internet to gather data; most use search engines like Google to assist this research. If an EHR is coupled with an effective decision support system, then this research can be delivered at the point of care, enabling the physician to make use of current information at his discretion.
Lastly, EHRs have the capacity to be used to improve care practices using real-time data from clinical settings. This is not done at the present time in the U.S. The gold standard for creating effective clinical treatment practices is the clinical trial with experimental and control groups. Developing protocols this way is costly and time consuming. An alternative to this approach is to use anonymous data from EHRs collected across a broad spectrum of practice settings. This data can then be analyzed with advanced research techniques including modern statistical analysis effective protocols based upon real-time data. The capacity to adopt this approach is becoming possible as medical groups involved in the Federal government’s EHR reimbursement program advance through stage 2 of meaningful use. An example of this capability is Sweden’s creation of a data registry on heart attacks using clinical data. The registry has been instrumental in reducing 30-day mortality by 65%.
The adoption of EHRs is advancing quickly and more than half of all clinical settings use one. I think that the capabilities for delivering great care with the assistance of EHRs is largely untapped. I believe that the present state of adoption is much like the early adoption of computers and Microsoft Office software in business settings. Increased efficiencies and savings were not achieved in the first ten years or so of adoption in business settings. Now, who can imagine an effective business without computers as an integral part of delivering products and services. Hopefully, the widespread adoption of EHRs will not take so long to achieve significant improvements in care and savings.
Donald Tex Bryant is a consultant who helps healthcare providers meet their challenges. He can be reached at Bryant’s Healthcare Solutions.
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